Economic evaluations of lymphatic filariasis interventions: a systematic review and research needs

Gedge, Lukyn M.; Bettis, Alison A.; Bradley, Mark H.; Hollingsworth, T. Déirdre; Turner, Hugo C.

doi:10.1186/s13071-018-2616-z

Parasites & Vectors

Table 1 Summary of the identified cost-effectiveness analyses

From: Economic evaluations of lymphatic filariasis interventions: a systematic review and research needs

Study	Research question	Study region	Time horizon	Intervention	Effectiveness metrics	Primary conclusions	Cost sources
Standard interventions
[20]	The incremental cost-effectiveness associated with different intensities of scaling-up annual MDA coverage within the GPELF	Global	50 years	Three different rates of scaling-up the MDA coverage of the GPELF (Erad1, Erad2, Erad3-see legend)	DALYs averted	• The faster the coverage of the MDA programmes is scaled up, the greater the health gains and cost-effectiveness of the GPELF	^b
						• This analysis suggests that more intense forms of scale-up are most likely to be cost-effective, lending further support to intensifying LF elimination efforts:
						• Erad1 scenario^a: US$ 219 (95% CrI: 142.65–322.72) per incremental DALY averted
						• Erad2 scenario: US$ 120.7 (95% CrI: 79.47–177.70) per incremental DALY averted
						• Erad3 scenario: US$ 72.94 (95% CrI: 47.74–109.80) per incremental DALY averted
						• Costs are in 2012 US$
[36]	Estimating an infection threshold that achieves control of LF-related disease	Tanzania	Not explicitly stated	Annual MDA for 5 (control) vs 10 years (elimination)	Prevalent cases cured	• A prevalence of microfilarial infection below a threshold of approximately 3.55%^c could constitute an achievable and sustainable target to control LF related disease	[94, 95]
						• Due to the high marginal cost of curing the last few individuals for elimination, the maximal benefits of LF control can occur at this threshold
						• Cost year not clearly stated
[2]	A preliminary cost-effectiveness estimate of the MDA provided by the GPELF (2000–2007)	Global	Lifetime of the benefit cohort resulting from the MDA provided between 2000 and 2007	Annual MDA	DALYs averted	• Assuming a treatment cost of US$ 0.10 per person would result in a cost per DALY averted of US$ 5.90	na
[16]	Cost-effectiveness of annual MDA	Based on data from India	30 years	Annual MDA (Control, Elim1, Elim2 - see legend)	DALYs averted	• It was estimated that in high prevalence areas, achieving elimination with MDA is highly cost-effective	Not explicitly stated
						• Even if elimination is not achieved and the treatment programme is continued for 30 years, MDA would still be considered highly cost-effective:
						• Control scenario: US$ 29 per DALY averted
						• Elim1 scenario: US$ 4.40 per DALY averted
						• Elim2 scenario: US$ 8.10 per DALY averted
						• Cost year not clearly stated
[17]	Cost-effectiveness of the MDA provided by the GPELF (2000–2014)	Global	Lifetime of the benefit cohort resulting from the MDA provided between 2000 and 2014	Annual MDA	DALYs averted	• The projected cost-effectiveness of MDA was high and robust over a wide range of costs and assumptions:	[53]
						• Using financial costs: US$ 24 (12–39) per DALY averted
						• Using economic costs excluding the donated drugs value: US$ 29 (14–48) per DALY averted
						• Using economic costs including the donated drugs value: US$ 64 (49–83) per DALY averted
						• The range is based on the predicted 95% confidence intervals for the treatment delivery costs
						• Costs are in 2014 US$
[17]	A preliminary cost-effectiveness analysis of a hydrocelectomy	Global	Lifetime of an average hydrocele patient	Hydrocele surgery	DALYs averted	• Under the health care provider’s perspective, it was projected that hydrocelectomy would be classed as highly cost-effective if the surgery cost < US$ 66, and cost-effective if < US$ 398 (based on the World Bank’s cost-effectiveness thresholds for low-income countries [18])	[96]
						• When using the societal perspective (which also includes the patients’ costs-such as for transportation and from lost wages) these results changed to US$ 29 and US$ 361, respectively
						• Costs are in 2014 US$
Alternative interventions
[35]	How increasing MDA frequency to twice per year could affect the treatment programmes duration and total cost	India & West Africa	Up to 20 treatment rounds	Biannual (twice a year) vs annual MDA	Programme duration and total cost	• Model predictions suggested in most scenarios a biannual MDA strategy would require the same number of treatment rounds to achieve LF elimination as an annual MDA strategy	India: [97], West, Africa: [47]
						• Thus, biannual MDA programmes should achieve elimination in half of the time
						• When excluding the economic value of the donated drugs the total programme costs for biannual MDA were projected to be lower in most scenarios
						• When including the value of the donated drugs, biannual MDA remained the cheaper strategy in most of the Indian scenarios, but became slightly more expensive in the West African scenarios
						• Costs are in 2009 US$
[16]	Cost-effectiveness of vector control	Based on data from India	30 years	Vector control (Control, Elim1, Elim2 - see legend)	DALYs averted	• Control scenario: US$ 302.50 per DALY averted	Not explicitly stated
						• Elim1 scenario: US$ 47.50 per DALY averted
						• Elim2 scenario: US$ 84.30 per DALY averted
						• Cost year not clearly stated
[16]	Cost-effectiveness of DEC-fortified salt	Based on data from India	30 years	DEC-fortified salt (Control, Elim1, Elim2 - see legend)	DALYs averted	• Control scenario: US$ 46.48 per DALY averted	Not explicitly stated
						• Elim1 scenario: US$ 1.10 per DALY averted
						• Elim2 scenario: US$ 3.62 per DALY averted
						• Cost year not clearly stated
[94]	The cost-effectiveness of four different mass DEC chemotherapy regimens	Tanzania	2 years	(i) Standard dose daily for 12 days	Prevalent cases cured	• The most cost-effective strategy was found to be the low monthly dose of DEC treatment	Presented in the same paper
				(ii) Biannual standard doses for a year		• However, the sensitivity analyses indicated that the optimal choice of DEC strategy was sensitive to the assumed programme design
				(iii) Low dose given monthly for a year		• The results suggested that if the delivery structure was simplified, DEC-medicated cooking salt had the potential to be the dominant intervention
				(iv) Distributing DEC-fortified salt for a year		• Costs are in 1995 US$
[37]	Cost-effectiveness analysis of using a combination of both vector control and MDA	India	5 years	Combination of 2 annual rounds of MDA and vector control activities (lasting 3 years) vs 2 annual rounds of MDA alone	(i) Infective bites prevented	• Integration of vector control with MDA did not appear to be cost-effective in this setting	Presented in the same paper
						• MDA alone:
						• Cost per infective larva prevented: US $3.14
						• Cost to reduce microfilarial prevalence by 1%: US$ 96.62
						• Combination of vector control and MDA:
						• Incremental cost per additional infective larva prevented: US$ 16.32
						• Incremental cost per additional 1% reduction in microfilarial prevalence: US$ 1451.97
					(ii) Infective larvae prevented	• Incremental cost of stopping each additional infective bite/villager: US$ 46.92
					(iii) Prevalence averted	• Costs are in 1997 US$

Abbreviations: CrI credible interval, DALYs disability-adjusted life years, DEC diethylcarbamazine, GPELF Global Programme to Eliminate Lymphatic Filariasis, LF lymphatic filariasis, MDA mass drug administration, na not applicable
^aMeasured against the elimination scenario as the comparator (mirroring the current rate of MDA scale-up, but assuming that the countries that have not yet begun MDA programmes will not do so)
^bManuscript in preparation at the time of that publication
^cBlood sampling volume of 1 ml
Erad1; expanding annual MDA to all endemic areas at the historical average rate of scale-up, Erad2; countries scale-up geographic coverage of annual MDA by 20% increments each year, Erad3; All countries expand coverage of annual MDA to their entire at-risk population immediately. Control; transmission is brought to low levels but not interrupted and where control efforts will have to continue (for the full-time horizon). Elim1; sustained interruption of transmission is achieved after a short period of intervention (6 years of annual MDA or 10 years of vector control or 2 years of DEC-fortified salt). Elim2; sustained interruption of transmission is achieved after a longer period of intervention (10 years of annual MDA or 15 years of vector control or 4 years of DEC-fortified salt)

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ISSN: 1756-3305

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